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The Principle of Specificity UNDERLYING MOST of the criticisms regular physicians brought against rationalistic systems of practice was the objection that they fostered mechanical, indiscriminate treatment. That physicians actively re­ garded the specter of treatment by rote as such a menace to both therapeutic success and the profession's standing reflects the pivotal place the principle of specificity occupied in professional values. Spec­ ificity—an individualized match between medical therapy and the spe­ cific characteristics of a particular patient and of the social and physical environments—was an essential component of proper therapeutics. Treatment was to be sensitively gauged not to a disease entity but to such distinctive features of the patient as age, gender, ethnicity, so­ cioeconomic position, and moral status, and to attributes of place like climate, topography, and population density. The commitment of American physicians to therapeuticspecific­ ity was remarkably durable. Despite the dramatic upheavals that oc­ curred in therapeutic theory, epistemology, and practice during the first two-thirds of the nineteenth century, the principle of specificity endured virtually uncontested as a central dogma in the regular ther­ apeutic belief system. Not until the late 1860s did its primacy begin to weaken substantially. Admonitions to heed the various elements encompassed by the principle of specificity permeated therapeutic instruction. A medical teacher in Ann Arbor in 1855, for example, itemized the "circum­ stances which modify indications" for correct treatment: "Age of the patient. The Sex . . . Constitution . . . The temperament. The disease going on in the organ. Idiosyncrasies, or personal peculiarities. Varia­ tion of the pulse. Habits of the patient. Tolerance of medicines. Cli- The Principle of Specificity 59 mate. The prevailing epidemic influence. Race. Profession. Severity of the disease."1 Professors routinely taught that such individuating fac­ tors as race, age, gender, diet, habit, occupation, climate, and season modified the character of disease and the operation of drugs, which last was also influenced by the form, dose, and combination of medi­ cines administered.2 Concrete directives for exercising specificity per­ vaded therapeutic discourse. The commitment to the principle of specificity gave therapeutic knowledge an epistemological status fundamentally distinct from that of the basic medical sciences at least through the 1860s. In contrast to such branches of medicine as anatomy, physiology, and chemistry and to the mechanical manipulations of surgical and dental treat­ ments,3 which were universalized in their generation and validation, medical therapeutics was specific to patient and place. Constructing universally applicable rules of practice was a wrong-headed endeavor, for the validity of therapeutic knowledge was restricted to a type of patient and environment that closely approximated those from which it had been drawn in the first place. "Idiosyncrasy, or the peculiarities of the individual, are as anomalous and impossible to reduce to rule and measure, as the passage of the clouds,"a Boston physician asserted. "What is true of one place may not be true of another."4 By stressing the specificity, not universalism, of therapeutic (and to some extent diagnostic and prognostic) knowledge, physicians expressed their con­ viction that knowledge pertinent for certain places or individuals could be inappropriate for others, directing practice that was dangerous to the patient and to the physician's reputation. In establishing the limitations specificity placed on generalizing therapeutic precepts, physicians took care to point out that this did not draw into question the universality of certain other categories of medical knowledge. The qualifying footnote a South Carolinian ap­ pended to his translation of Broussais was typical: "The Southern cli­ mate of the United States seems to require more bold and decisive practice, than the Northern climate of Paris and London: hence, to us, the therapeutics of Broussais . ..appear feeble; but the principles,founded on the physiology and pathology of the tissues, are undeniable and universally applicable."s The same distinction between the universal basic medical sciences and principles of medicine on the one hand and region-specific therapeutic knowledge on the other supported the no­ tion that, as one medical editorput it, "while the principles of medicine are uniform, its practice must be learned in the locality in which these principles are to be applied."6 Thus an Alabama physician arguing vigorously that southern students must learn at southern bedsides made it clear that he was pleading for the specificity only of therapeutics. 60 ANTEBELLUM MEDICAL THERAPEUTICS "As to the study of the rudiments of the science of medicine, (Anatomy, Physiology, and Chemistry,) they can be learned North, as well as South, for they are the same everywhere," he...


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